Cardiology · USMLE Step 1 and Step 2

Stable Angina song

Stable Angina - Diagnosis & Management, as a song. Hear the short teaser here. The full song is on YouTube and Spotify.

Stable Angina

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Key points in this song10

Stable angina results from fixed atherosclerotic coronary artery stenosis causing demand-ischemia: chest pain precipitated by exertion or emotional stress and relieved by rest or nitroglycerin within minutes.
The classic presentation is substernal chest pressure, described as "squeezing" or "heaviness," radiating to the left arm or jaw, reproducible with the same level of exertion each time.
First-line pharmacologic treatment is sublingual nitroglycerin for acute episodes; beta-blockers are first-line for long-term symptom prevention by reducing heart rate, contractility, and myocardial oxygen demand.
Aspirin and statins are cornerstone secondary prevention agents in all patients with stable angina due to underlying coronary artery disease.
Calcium channel blockers (amlodipine) and long-acting nitrates are used as add-on or alternative antianginal therapy when beta-blockers are contraindicated or insufficient.
Ranolazine inhibits late sodium current to reduce intracellular calcium overload and is used as adjunctive therapy for refractory stable angina without significantly affecting heart rate or blood pressure.
Stress testing (exercise treadmill ECG) is the standard initial diagnostic workup; ST-segment depression ≥1 mm during exercise is the classic positive finding indicating inducible ischemia.
Coronary angiography is the gold standard for definitive diagnosis; revascularization (PCI or CABG) improves symptoms but does not reduce MI or mortality in stable angina compared to optimal medical therapy.
CABG is preferred over PCI in patients with left main disease, three-vessel disease, or two-vessel disease involving the proximal LAD, especially with reduced ejection fraction or diabetes.
Unlike unstable angina, stable angina has no plaque rupture or thrombus formation, troponin remains negative, and symptoms are predictable and resolved completely by rest or nitroglycerin.